Healthcare Provider Details

I. General information

NPI: 1588059570
Provider Name (Legal Business Name): NEENA R CHERAYIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 02/17/2022
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 1520
CHICAGO IL
60611-3111
US

IV. Provider business mailing address

259 E ERIE ST STE 1520
CHICAGO IL
60611-3111
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8150
  • Fax: 312-695-3652
Mailing address:
  • Phone: 312-695-8150
  • Fax: 312-695-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036.152247
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number036.152247
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: